Provider Demographics
NPI:1053551069
Name:GREEN, LAURA K (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12332 W 85TH TER APT 1013
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4574
Mailing Address - Country:US
Mailing Address - Phone:913-231-7495
Mailing Address - Fax:
Practice Address - Street 1:14188 W 150TH CT
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3367
Practice Address - Country:US
Practice Address - Phone:913-829-7775
Practice Address - Fax:913-829-7765
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist